Notes from the Academy

 Humanistic Psychotherapy

The entire text is available at www.academyprojects.org/alternatives.htm 

In July 2003, the Academy Board voted to adopt in principle Division 32’s Humanistic Psychology’s “Recommended Principles and Practices for the Provision of Humanistic Psychosocial Services.”  The authors clearly differentiate the approach represented by those who are pressing for narrowly defined "evidence-based treatment" and the approach taken by humanistic psychologists.  While there are, of course, differences between humanistic and psychoanalytic psychotherapy, we believe we have much in common and that Division 32’s Recommendations are an important statement of the incompatibility of  some kinds of psychotherapy (including our own) with the medical model and all that goes with it. We reprint a portion of these Recommendations here.  

We are interested in hearing from our members about these guidelines or any other matters of interest.  Please write to Lynne Tenbusch, Ph.D., Academy President, at lynnegtenbusch@wwnet.com

Humanistic Psychotherapy

Humanistic therapies generally are seen as providing opportunities for self-confrontation, personal exploration, and growth as the means by which individuals confront their suffering, their limits, and their distress. As such these therapies do not typically provide specific treatment packages for specific disorders. In fact, “disorder” is not usually a meaningful category for defining the aim of a humanistic therapy. Rather, humanistic therapies aim to facilitate more general human capacities for being in the world as a way of helping individuals confront and cope with their problems in living. As a result humanists tailor their approaches to individuals not on the basis of the individual's disorder, but on the basis of the individual as a unique person. Work done with one person presenting as depressed might be more similar to work with a person labeled as schizophrenic than to that done with another person presenting as depressed. Because all humans think, experience, value, have aspirations and wishes, engage themselves in life, and make choices, the kinds of experiences humanistic therapists provide could be useful, regardless of an individual's diagnosis.

 Outcome possibilities 

Psychological problems, or problems in living, are ultimately resolved by helping individuals develop more complex, integrative, balanced, honest, and courageous ways of living, i.e. through psychological growth. Psychological growth consists of creating more deep and complex integrative modes of relating to self and to others, and of new stances of meaning. The goal is not primarily to remedy dysfunction, although humanistic therapists acknowledge problematic behavior and experience and help clients stay with it and learn from it. At times humanistic psychologists may even use symptom-focused procedures to help alleviate problem behaviors and experience, but this is done as part of the larger context of exploring broad personal issues and problems of meaning.

Problems in living are often not isolated entities in themselves to simply be removed. As individuals confront issues concerning their basic values and engagement in the world, they will also confront issues relating to their problems. In some cases problems in living can be modified by focusing on the enhancement of people's resources and the fulfillment of their potential, without therapy even addressing the issue of the problem behaviors and experience. As an example, a person with a physical problem, such as cancer or paralysis, can still find ways to live a productive life. Likewise, even if something that might be conceived of as a psychological “disorder” has a biochemical component, individuals can learn from the experience and incorporate it into their lives in a functional (or even creative) manner. On the other hand, there are instances where the painful issues associated with a symptom need to be explored, beyond the use of procedures to facilitate symptom removal.

Humanistic therapies also value the following goals: making the development of freedom and wholeness available to clients, to the degree that they can engage in them; enlarging the person's sense of possibility; helping the person become more aware, sensitive, and capable of choice; and increasing life's vitality—creativity, meaning, purpose, and intimacy with self and others. The aim for many humanistic therapies is to help clients attain a greater sense of personal freedom. Freedom is defined as the capacity for choice within the natural and self-imposed limits of living. Yet another goal of humanistic therapies, if clients so wish, may be to help them develop deeper capacities for experiencing in the ways they relate to themselves and the world. Included in this may be the development of transpersonal aspects of the self. Transpersonal aspects may include spiritual aspects, or may be nonspiritual, but still include a deeper relational sense of connection to others, to being, and to life.

Outcome from a humanistic perspective is highly individualized. While recognizing the ever present possibility that people—and this applies equally to therapists and clients—are sometimes self-deceiving, the humanistic psychologist nevertheless accepts that ultimately what is a successful outcome can only be best judged by the consumer.  

Processes and procedures  

In practice, humanistic psychotherapies are not typically goal-driven in the sense that they set out to specifically achieve a particular set of predefined goals, such as overcoming shyness, learning to communicate better, or feeling less anxious. Some humanistic therapies (e.g., Mahrer's, 1996, experiential therapy) are not goal-driven at all in the sense of trying to achieve particular outcomes, and in that sense are almost purely process and discovery oriented. When goals are decided upon, they are decided upon by the therapist-client team. However goals often change and evolve as the therapy process progresses. In any given therapy encounter it is often not possible to specifically predict in advance what kinds of positive outcomes will ultimately emerge as the relationship evolves and changes. Outcomes are often creative emergents (Kampis, 1991), such as second-order changes (Watzlawick, 1987).

Instead of focusing on specific outcome goals, humanistic therapists typically focus attention on process. In general therapists want to take humans seriously in terms of their own experience, “salve the human spirit,” and help individuals discover how they want to promote their own development, and by so doing, cope with problems in living. In order to do this therapists aim to provide an optimal relational process within which a client can reflect upon the patterns of his or her life, experience him or herself more deeply, access or mobilize his or her own capacity for agency, and experience and explore the formation and function of relational bonds. In this regard the humanistic therapist allows the client to stay close to his or her suffering and to learn from it. However, distress is seen as one aspect of the whole person, and the ultimate focus of the therapy is more on the whole person's engagement with self and with life.

Therapists provide such an optimal relational process first by keeping in mind the humanness of the therapeutic encounter. Both psychological problems and their alleviation are seen as ultimately involving the humanness of the participants. Thus post-traumatic fears are not treated simply as pathogens to be deconditioned or emotionally reprocessed through exposure…. 

Second, therapists facilitate an optimal context by keeping their attention primarily focused in the moment and on the experience of this unique individual. Sensitive, skilled, and flexible attending to the ongoing emerging process between therapist and client is the sina qua non of humanistic therapy. Therapists sensitively track the experience of the client as the client struggles with issues and experience, track emerging themes, and bring in suggestions, ideas, and techniques when they are relevant to what is happening in the moment. Therapists keep their attention focused more on what is unique about this particular client than on what is common about him or her with respect to others who may share the same presenting complaint or diagnostic category.  Therapy therefore consists of an open-ended process oriented towards discovery and meaning-making. The therapist functions as a skilled and disciplined improvisational artist, not as a technician implementing a treatment manual. Therapists may use any of a variety of techniques, such as cognitive restructuring or exploring childhood experiences. However these are suggested only when they fit the needs of this particular individual in this particular moment in the therapy process.

Third, therapists provide an optimal relational process by exercising certain other core skills. Minimally, these include the ability to: a) empathically understand and grasp the world of the client, b) accept, affirm, value, or prize the client, and c) facilitate and participate in co-constructive dialogue with the client. Additionally, most humanistic therapists also try to optimize the relational process by: a) being a real self-in-relation to the client, and b) genuinely engaging in a “meeting of persons” with the client.

Fourth, the therapist believes that clients are the ultimate experts on their own experience. Ultimately it is clients who must decide, within the constraints of their life structure and of society, what changes to make and how to make them. Humanistic therapists hold a basic respect for the personal reality of clients. In addition clients are seen as authentic sources of their own experience. Further, humanistic therapists relate to the client out of a genuinely held egalitarian stance. In such a model, it is paradigmatically incoherent to: a) think of the client and the process of therapy primarily in terms of the “expert therapist's” assessment of the client's “disorder,” and b) approach therapy with a pre-defined “treatment plan” based upon that assessment. Doing so interferes with the therapist’s capacity for tuning into client uniqueness, individuality, strength, and potential.

Fifth, a major therapeutic issue for many clients has to do with their personal theories of living. There often is a philosophical or moral component to therapy, and therapy can be the facilitation of clients confronting certain basic issues and values about being human and being alive. Therapists help clients more meaningfully “restory” their lives to create a deeper sense of personal meaning.

Sixth, therapy for many clients revolves around a basic struggle to achieve both a sense of genuineness and intimacy in relationship to other human beings. The resolution of this struggle cannot be manualized, nor “treated” with a “treatment plan.” Instead, the therapist must be present as another human being and be willing to be a part of that struggle.

Humanistic therapies are thus not based on the medical model. To quote Bohart, O'Hara, and Leitner (1997), “ In contrast to therapy as the mechanical application of a treatment procedure, therapy is a recursive, self-adjusting, creative, interactive intelligent process (Karen Tallman, personal communication, October, 1996), a complex nonlinear dynamic system.” Therapist and client are the two major variables in the approach; rather than treatment and disorder, as is the case for the EST criteria. Dialogue, instead of preset choice and application of technique, is the sina qua non of the process. The process of the therapist and client listening to one another and interacting is primary, with theoretical ideas and techniques used as aids or adjuncts in that process. ... Therefore there is no such thing as an invariant procedure uniformly applied across the board to clients who share the same diagnosis. The therapist-client pair working together is the “treatment of choice,” rather than any specific treatment package. As Bohart, O'Hara, and Leitner (1997) note: A therapist's particular theoretical stance and package of techniques are ways to implement his or her therapeutic interpersonal presence and spontaneity, rather than specific things done to make therapy happen. Different therapists can practice in widely different ways, use widely different techniques at given choice points, and still be effective if they are implementing certain fundamental humanistic principles. Thus, uniformity of therapist behavior is neither expected nor desired. What is desirable is that therapists individually “be themselves” in their own unique idiosyncratic “healing ways.” Therapists will not necessarily even be consistent from one moment to the next, as they flexibly adjust to the emerging flow of interaction between themselves and the client. This includes the therapist's own continual self-discovery of new potentialities for helpful interaction through dialogue with this particular client.

Based on these core, generic principles, humanistic therapists practice in widely different ways. In all cases, humanistic practitioners recognize that their particular philosophical and theoretical positions are guiding frames of reference for interaction and practice, but are not “the truth” to be imposed on their clients. The reality of the client, of the client's own experience, and of the experiential reality created by the intersection of the therapist's reality and the client's reality, is the ultimate determinant of practice in humanistic therapy.